Measuring Quality, Part 2: How Physician Quality Should Be Measured

Categories: E-Books, For Employers, Quality

This white paper was co-written by Sasha Small and Nate Freese.

 

In Part 1 of our three-part blog series on measuring quality, we unpack the problem of why members aren’t getting matched with high-quality care. In Part 2, we go over the importance of measuring quality and how we go about evaluating practicing physicians across all specialties and geographies.

 

Balancing Data With Clinical Expertise to Measure Provider Quality

At Grand Rounds, a combination of data and clinical expertise serves as the foundation for how we measure provider quality. To that end, we’ve brought together an exceptional team of 100-plus clinicians and more than 35 data experts, who work hand in hand to develop finely tuned machine-learning models.

These models are fed a broad set of data, which includes: 

  • claims data: commercial, multi-carrier and customer claims, including labor customers
  • health outcomes data: state registries and specialty societies
  • additional data: medical associations, specialty boards, disability
  • Grand Rounds data: expert opinions, after-care summaries, member surveys

This combination of commercial, labor, and proprietary data makes it possible to evaluate provider quality across 96% of the practicing physicians in the U.S. And it covers every medical specialty recognized by the American Medical Association.

 

How Grand Rounds Defines Physician Quality

We determine a physician’s performance across four dimensions:

  1. Safety
  2. Effectiveness
  3. Price
  4. Efficiency

Our models are set up to identify providers practicing unsafe medicine that puts their members at risk—for example, doctors with high-dose opioid or benzodiazepine prescribing patterns, which can lead to addiction and overdose.

In addition, we optimize for clinicians who effectively resolve members’ clinical needs. This includes a number of metrics such as medication adherence and preventive screening measures along with the quality of referrals made to specialists. 

Our methodology also ensures that recommended providers deliver the highest-quality care at an affordable price. We’re able to bubble up these providers by prioritizing doctors who charge lower prices and are resource-efficient, using the minimum number of visits, treatments or tests necessary to provide the best care possible.

By aggregating a quality score across these four domains, we’re able to present the highest-quality doctors as the top results in our referral rankings. Lower-scoring doctors fall to the bottom of the list. By routing members away from lower-quality providers and towards high-quality doctors, members on the Grand Rounds platform have experienced a 3.1% reduction in emergency department (ED) visits.

 

Check back soon for the final installment of this blog series on measuring quality. In Part 3, we’ll examine how the Grand Rounds approach is truly differentiated and personalized.

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